92 Decision Citation: BVA 92-15658
Y92
BOARD OF VETERANS' APPEALS
WASHINGTON, D.C. 20420
DOCKET NO. 92-01 315 ) DATE
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THE ISSUE
Whether new and material evidence has been submitted to
reopen the claim of entitlement to service connection for an
acquired psychiatric disorder, including post-traumatic
stress disorder.
REPRESENTATION
Appellant represented by: Department of Veterans Affairs,
Virginia
WITNESS AT HEARING ON APPEAL
The appellant
ATTORNEY FOR THE BOARD
Siobhan Brogdon, Associate Counsel
INTRODUCTION
Entitlement to service connection for an acquired
psychiatric disorder, including post-traumatic stress
disorder, was denied by rating actions dated in 1985. The
veteran did not file a timely appeal from these
determinations, and those decisions became final.
The current matter came before the Board on appeal from a
rating decision of January 1991 from the Roanoke, Virginia
Regional Office (hereinafter RO). The veteran served on
active duty from August 1941 until November 1945. The
notice of disagreement was received in March 1991. The
statement of the case was issued in April 1991. The
substantive appeal was received in June 1991. The veteran
was afforded a personal hearing at the originating agency in
July 1991. A supplemental statement of the case was
furnished in October 1991. The claims folder was received
and docketed at the Board in March 1992. The appellant is
represented in this matter by the Virginia Department of
Veterans Affairs. The case is now ready for appellate
review.
REMAND
The record discloses that the veteran served in the Pacific
Theater of Operations and participated in a number of
campaigns and operations against the enemy including the
capture and defense of Guadalcanal and Iwo Jima. He was
wounded in combat and received medals which included the
Purple Heart and the Bronze Star. During his hearing at the
RO in July 1991, he asserted that he saw a great deal of
combat, and had had nightmares and flashbacks of his wartime
experiences since leaving active duty. He related that he
had first sought treatment for nerves in 1947 or 1948, and
still had guilt feelings about surviving the war while
others did not.
A careful review of the record discloses that the veteran
was considered to have manifestations of nervous tension
upon VA examination in October 1948. Symptoms of
restlessness and an "acute excitable state" were indicated
in a private medical statement of April 1977. The veteran
was hospitalized in November 1978 with complaints which
included tension, restlessness and inability to sleep. His
family reported that "he was not himself" and had been
carrying a gun in the front seat of his car. A diagnosis of
psychotic depression with paranoid features was given at
that time. The subsequent record reflects continuing
psychiatric treatment with diagnoses noted which included
bipolar disorder, mania and Parkinson's Disease with
secondary dementia. In this regard, it is noted that,
following three days of hospitalization by the VA in
February 1991, it was determined by VA physicians that the
veteran was not competent to manage his affairs. He was
described as having no acute psychiatric problems. Because
of worsening dementia, nursing home placement was discussed
during at least 2 VA hospitalizations. The veteran was
afforded a post-traumatic stress disorder evaluation at a VA
medical facility in March 1992 and a primary Axis I
diagnosis of post-traumatic stress disorder, chronic,
severe, was rendered. That diagnosis was made by a clinical
psychologist, a psychiological examiner, and a readjustment
counselor. It was felt that he did not have dementia.
The record indicates that the veteran has not had a
compensation and pension examination for pension purposes
since 1948. In his correspondence to the RO in January 1991
and in his substantive appeal, the veteran requested
psychiatric evaluation. It is claimed that his psychiatric
disorder has been misdiagnosed.
VA has a duty to assist the veteran in the development of
facts pertinent to his claim. The Court of Veterans Appeals
has held that this duty includes VA examination by a
specialist, when indicated. Under the circumstances of this
case and in order to reconcile the diagnoses of record, the
Board is of the opinion that additional assistance is
required. The case is, therefore, REMANDED to the RO for
the following action:
The veteran should be scheduled for a
period of observation and evaluation at a
VAMC and for a special VA psychiatric
evaluation by a board of at least two
Department of Veterans Affairs
psychiatrists who have not examined him
previously, to determine the nature and
extent of any psychiatric disability now
present. All indicated special studies,
including psychological testing, should
be accomplished. The examiners should
refer to Chapters 14 and 20 of the
Physician's Guide for Disability
Evaluations Examinations. Reconciliation
of all psychiatric diagnoses is to be
accomplished with supportive rationale
provided in detail. Special attention
should be directed to the veteran's
claimed post-traumatic stress disorder,
particularly whether any current signs
and symptoms fall within the diagnostic
criteria set forth for this disorder.
The history reported by the veteran
should be matched by any noted in the
record. The claims folder should be made
available to the examiners prior to the
period of evaluation.
Following completion of this action, the agency of original
jurisdiction should review the evidence and determine
whether the veteran's claim may now be allowed. If not, the
veteran should be provided with an appropriate supplemental
statement of the case and the case should be returned to the
Board for further appellate consideration.
BOARD OF VETERANS' APPEALS
WASHINGTON, D.C. 20420
*
NANCY R. ROBIN (MEMBER TEMPORARILY ABSENT)
ALBERT D. TUTERA
*38 U.S.C. § 7102(a)(2)(A) (1992) permits a Board of
Veterans' Appeals Section, upon direction of the Chairman of
the Board, to proceed with the transaction of business
without awaiting assignment of an additional Member to the
Section when the Section is composed of fewer than three
Members due to absence of a Member, vacancy on the Board or
inability of the Member assigned to the Section to serve on
the panel. The Chairman has directed that the Section
proceed with the transaction of business, including the
issuance of decisions, without awaiting the assignment of a
third Member.
Under 38 U.S.C. § 7252 (1992), only a decision of the Board
of Veterans' Appeals is appealable to the United States
Court of Veterans Appeals. This remand is in the nature of
a preliminary order and does not constitute a decision of
the Board on the merits of your appeal.